Traitement chirurgical des fractures transversales et obliques courtes de la diaphyse du cinquième métacarpien : simple ou double brochage centromédullaire ?

Médecine. Chirurgie généraleRésumé : les fractures du 5ème métacarpien sont parmi les fractures les plus fréquentes du membre supérieur. Après quelques rappels biomécaniques, nous expliciterons les différentes méthodes de traitement, puis nous comparerons le traitement chirugical des fractures transversales et obliques courtes des la diaphyse du 5ème métacarpien par 2 techniques de brochage centromédullaire: une broche simple dans 20 cas (groupe 1) versus 2 broches reliées par connecteur de type MetaHUS® dans 20 cas (groupe 2). Une immobilisation par orthèse en position intrinsèque plus a été mise en place pendant 1 mois dans le groupe 1, il n'y avait pas d'immobilisation post-opératoire dans le groupe 2. Au dernier recul, la force de la poigne était en moyenne de 94,65% dans le groupe 1 et de 94,35% dans le groupe 2. La probabilité que la force de la poigne soit équivalente dans les 2 groupes était de 99,72%. L'extension active de la métacarpophalangienne était en moyenne de 98,5% dans le groupe 1 vs 98,75% dans le groupe 2. La probabilité que l'extension active soit équivalente dans les 2 groupes était de 98,56%. Toutes les fractures ont consolidées; aucune reprise chirurgicale n'a été notée. On notait 3 complications: 2 infections sur broches, et un cas de syndrome douloureux régional complexe. Au total, nos résultats semblent montrer que la technique chirurgicale du double brochage centromédullaire dans le traitement des fractures transversales et obliques courtes de la diaphyse du 5ème métacarpien est simple et reproductible.Sumary : fifth metacarpal fracture are common. There is no consensus about surgical treatment. The aim of this work was to compare intramedullary nailing with one single K-wire versus two K-wires connected together externally. Our series included 40 transverse or short oblique shaft fracture of the fifth metacarpal treated by one single intramedullary nailing (group 1), or two double intramedullary nailing called MetaHUS® (group 2). There were no statistically significant differences for all criteria except sick leave for rehabilitation, which was less important for group 2. All fractures healed. There were no malunion, nor malrotation. Our results showed that intramedullary nailing with two K-wires connected together externally (MetaHUS®) is a technique of choice for the treatment of displaced transverse and short oblique shaft fracture of the fifth metacarpal

Isoelastic resurfacing prosthesis for distal radius fractures: Outcomes in 24 cases with at least 2 years’ follow-up

International audienceBackground: Unicompartmental resurfacing prostheses have been reported to be useful for treating comminuted fractures involving the distal radial joint surface in elderly patients with osteoporosis. However, the data on this method remain scarce and further evaluations are needed. The objective of this study was to evaluate the clinical and radiological outcomes after unicompartmental resurfacing prosthesis implantation in patients with distal radius fractures and at least 2 years' follow-up.Hypothesis: Outcomes with Prosthelast® are as good in the mid-term as in the short term.Materials and methods: We studied 24 patients with type C fractures in the AO classification. The Prosthelast® prosthesis was implanted in each. Mean age was 78 years (60 to 91). There were 22 females. Three of the fractures were open. The patients were evaluated clinically using a visual analogue scale (VAS) for pain, ranges of motion at the wrist, and grip strength. In addition, functional scores were determined, and radiographs obtained.Results: Mean follow-up was 55.2 months (24-97). Mean tourniquet time was 61.9minutes (37-126). Mean motion ranges were 39° in flexion, 49° in extension, 74° in pronation, and 68° in supination. The mean VAS pain score was 2.1 (0-7). The mean Quick DASH was 39.8 (9.09-77), the mean PRWE was 42.7 (5-95), and mean grip strength was 38 (25-150). Painful motion limitation of the elbow was noted in a patient treated with total elbow prosthesis. Complex regional pain syndrome developed in 6 patients, and 5 patients required revision surgery. Asymptomatic perforation of the radial head occurred in 8 patients. No cases of peri-prosthetic osteolysis or osteoarthritis were noted. The prosthesis impinged on the lunate bone in 2 patients and on the scaphoid bone in one patient. Mean ulnar variance was +0.17mm (-1 to 7.5). Bone remodelling about the prosthesis was noted in all the patients, but 2.Discussion: Our data obtained after a mean follow-up of 55 months indicate that resurfacing prostheses have a role to play in the treatment of comminuted articular fractures in patients with osteoporosis. A long-term study is needed to further evaluate these results.Level of evidence: IV; therapeutic